@article{568a9188349d41179fbc58979c8fe834,
title = "ICTs and the challenge of health system transition in low and middle-income countries",
abstract = "The aim of this paper is to contribute to debates about how governments and other stakeholders can influence the application of ICTs to increase access to safe, effective and affordable treatment of common illnesses, especially by the poor. First, it argues that the health sector is best conceptualized as a 'knowledge economy'. This supports a broadened view of health service provision that includes formal and informal arrangements for the provision of medical advice and drugs. This is particularly important in countries with a pluralistic health system, with relatively underdeveloped institutional arrangements. It then argues that reframing the health sector as a knowledge economy allows us to circumvent the blind spots associated with donor-driven ICT-interventions and consider more broadly the forces that are driving e-health innovations. It draws on small case studies in Bangladesh and China to illustrate new types of organization and new kinds of relationship between organizations that are emerging. It argues that several factors have impeded the rapid diffusion of ICT innovations at scale including: the limited capacity of innovations to meet health service needs, the time it takes to build new kinds of partnership between public and private actors and participants in the health and communications sectors and the lack of a supportive regulatory environment. It emphasises the need to understand the political economy of the digital health knowledge economy and the new regulatory challenges likely to emerge. It concludes that governments will need to play a more active role to facilitate the diffusion of beneficial ICT innovations at scale and ensure that the overall pattern of health system development meets the needs of the population, including the poor.",
keywords = "Digital health, E-Health, Health knowledge economy, Universal health coverage",
author = "Gerald Bloom and Evangelia Berdou and Hilary Standing and Zhilei Guo and Alain Labrique",
note = "Funding Information: The data on Bangladesh are derived from a mapping and review of 26 e-health interventions in 2012 [37], a series of in-depth interviews with e-health innovators in Dhaka as part of a broader study of innovations and health system change in Bangladesh [36] and a survey of 800 households in rural and urban localities to study health information seeking behaviour and weighted towards lower income households [38]. These studies describe a variety of actors and emergent partnerships and networks. The Ministry of Health has established an e-health administrative unit, which is integrating ICTs into planning and management and establishing a telephone medical advice line. Several start-up companies have developed ICT applications and different knowledge intermediaries provide information on health issues on a website or in SMS messages. These intermediaries include large NGOs, research institutes, social businesses and private entrepreneurs based within and outside Bangladesh. These initiatives are mostly funded by grants from donor agencies or foundations. The study found several innovative partnerships and networks. One m-health company had linked to local (untrained) village doctors/drug sellers to offer a package of basic services. Another had partnered with a very large service delivery NGO and a national retail chain to create a website on maternal and child health and send SMS messages to pregnant women. Another national retail chain had established a health website and advice line, linked to an online shop. Several mobile phone operators had launched health advice lines. The study found that company leaders were enthusiastically seeking a niche in what they perceived to be a potentially large market in the future. However, the only ones that were financially secure were linked to an established retail chain or mobile phone operator. Publisher Copyright: {\textcopyright} 2017 The Author(s).",
year = "2017",
month = aug,
day = "7",
doi = "10.1186/s12992-017-0276-y",
language = "English (US)",
volume = "13",
journal = "Globalization and health",
issn = "1744-8603",
publisher = "BioMed Central",
number = "1",
}